Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, USA.
Public Health Network, Aden, Yemen.
Lancet Glob Health. 2023 Dec;11(12):e1955-e1963. doi: 10.1016/S2214-109X(23)00272-3.
Yemen continues to endure cholera outbreaks during ongoing conflict and destructive environmental events. Air raids have been used throughout the conflict to target military and civilian infrastructure. We aimed to assess the association between air raids and cholera incidence while taking into account geographical, environmental, economic, and demographic factors that drive outbreaks.
In this ecological modelling study, we used data from Sept 12, 2016, to Dec 29, 2019, for the number of air raids, vegetation coverage, surface water, precipitation, temperature, economic variables, and cholera case and population data to model the association between conflict and the weekly incidence of cholera (per 100 000 people) in Yemen. Data were transformed into weekly intervals and governorates were categorised according to air raid severity (the number of raids in the previous 3 months). We used a negative binomial generalised additive model that accounted for geographical location and environmental, temporal, economic, and demographic variables to estimate incidence rate ratios for the association between air raid severity and cases of cholera.
During the study period, 2 107 912 cases of cholera were reported in Yemen, and a minimum of 11 366 air raids were recorded. After controlling for relevant factors, compared with no air raids, all other levels of air raid severity were significantly associated with cholera incidence. The largest effect was noted in governorates with severe air raid levels (ie, ≥76 during the previous 3 months), which had an incidence rate ratio of 2·06 (95% CI 1·59-2·69; p<0·0001) for cholera compared with governorates with no air raids in the previous 3 months. Economic factors were also significantly associated with increased cholera incidence.
Air raids were significantly associated with the burden of cholera in Yemen, even after controlling for other relevant factors. Quantification of this relationship further shows that the cholera outbreak is largely a result of human action rather than a natural occurrence, and demonstrates the conflict's devastating effects on health. Our findings highlight the need for ceasefire and peacebuilding efforts, as well as infrastructure and economic restoration, to reduce Yemen's cholera burden.
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For the Arabic translation of the abstract see Supplementary Materials section.
也门在持续的冲突和破坏性环境事件中继续爆发霍乱。空袭在整个冲突中被用来针对军事和平民基础设施。我们旨在评估空袭与霍乱发病率之间的关联，同时考虑到导致疫情爆发的地理、环境、经济和人口因素。
在这项生态建模研究中，我们使用了 2016 年 9 月 12 日至 2019 年 12 月 29 日的数据，包括空袭次数、植被覆盖、地表水、降水、温度、经济变量以及霍乱病例和人口数据，以模拟冲突与也门霍乱每周发病率（每 10 万人）之间的关联。数据转换为每周间隔，根据空袭严重程度（前 3 个月的空袭次数）对各省进行分类。我们使用负二项广义加性模型，该模型考虑了地理位置以及环境、时间、经济和人口变量，以估计空袭严重程度与霍乱病例之间关联的发病率比值。
在研究期间，也门报告了 2107912 例霍乱病例，记录了至少 11366 次空袭。在控制了相关因素后，与没有空袭相比，所有其他级别的空袭严重程度均与霍乱发病率显著相关。在过去 3 个月空袭级别最高（即≥76 次）的省份，这种关联最为显著，其霍乱发病率比值为 2.06（95%CI 1.59-2.69；p<0.0001），与过去 3 个月没有空袭的省份相比。经济因素也与霍乱发病率的增加显著相关。
即使在控制了其他相关因素后，空袭仍与也门的霍乱负担显著相关。这种关系的量化进一步表明，霍乱的爆发主要是人为因素造成的，而不是自然发生的，并且表明冲突对健康造成了破坏性影响。我们的研究结果强调了停火与和平建设工作、基础设施和经济恢复的必要性，以减轻也门的霍乱负担。
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